Registration | NCGR Wrestling

Athlete Registration & Waiver

Athlete's First Name

Athlete's Last Name

Athlete's Birthdate

Athlete's Age

Athlete's Weight

Mom's Cell Phone

Mom's First Name

Mom's Email

Dad's Cell Phone

Dad's First Name

Dad's Email

Please specify anything we should know about (ie. health conditions, allergies, medications, etc.)

Emergency Contact Name (if parent is unavailable)

Phone Number

Relationship

I, the parent, or guardian, do hereby acknowledge this release from liability for accidental injury or illness which the child listed above may incur as a result of participating in any physical activity within the Nor Cal Gold Rush Wrestling Academy. I hereby assume all risks connected therewith and consent to my child’s participation in this program. I agree to disclose my child’s physical limitations, disabilities, ailments, or impairments which may affect their ability to participate in this program. I assume full responsibility for my child’s participation and give my child permission to participate.

I agree not to hold Nor Cal Gold Rush Wrestling Academy, Coaches, Trainers, Staff, Oak Ridge High School or El Dorado Union High School District liable for any negligence or consequences thereof during my child’s or my families participation in any activity at Nor Cal Gold Rush Wrestling Academy training facilities or traveling to and from an event.

I declare that the info I’ve provided is accurate & complete

Parent/Guardian's Name

Your Signature

Select a date

USA Wrestling Membership

Yes, my athlete has a current USA Wrestling membership.

No, my athlete does NOT have a current USA Wrestling membership.

We are a USA Wrestling sanctioned club. A USA Wrestling membership is required to participate. Please visit usawmembership.com/login to become a member and bring a copy of your registration to practice.

Monthly Fee

First month's fee is due upon completion of this form. Please select your athlete's age group below:

Mighty Mite Monthly Fee (3-7yrs old; 1 practice a week) - $85.00

Junior Monthly Fee (8-13yrs old; 2 practices a week) - $125.00